Objective To evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) for patients with fresh osteoporotic vertebral compression fracture (OVCF).Methods From February 2010 to November 2011,103 patients with fresh OVCF were assigned to receive either PVP or conservative treatment according to their choice or the choice of surgeons.There were no significant differences between the 2 groups regarding general clinical data (P ＞ 0.05).The pain was scored at pre-treatment,1,4,12,24 and 48 weeks post-treatment in all the patients.The vertebral re-fractures were recorded in both groups at follow-ups.The 2 groups were compared in terms of postoperative pain relief and risk of re-fracture.Results The overall pain relief at 1,4 and 12 post-treatment in the PVP group was significantly greater than in the conservative treatment group (P ＜ 0.05).The pain relief at night at 1,4 and 12 post-treatment was significantly greater in the PVP group than in the conservative treatment group (P ＜ 0.05).At one year post-treatment,7 vertebral re-fractures were observed in the PVP group (18.4％,7/38) and 12 ones in the conservative treatment group (20.3％,12/59),with no significant difference between the 2 groups in the risk of re-fracture (Hazard ratio =0.909,95％ CI:O.36 ～ 2.29,P =0.841).Conclusion Compared with conservative treatment,PVP may significantly reduce the pain for patients with fresh OVCF but does not increase the risk of vertebral re-fracture.

Objective To evaluate the reason of failure of the interlocking nail.Methods From1998-2001, 72 patients with femur fractures were treated with the interlocking nail.Results 61 cases were followed-up,there were 5 breakages in the locking nail. The failure occurred after operation from 4～9 months.And 3 cases were at the middle of the nail.2 cases were at the first screw of the distal of the fracture.Conclusion The reason of breakage concluded open operation,too much separation of the periosteum,too early full weight bearing and unfit function exercise.

BACKGROUND: The proliferation and differentiation of mesenchymal stem cells (MSCs) lack of regulatory functions. Following combining with suitable vectors, MSCs cannot highly effectively proliferate and differentiate, which are keys to prevent MSCs entering the clinic. It is of great importance to effectively regulate the differentiation of stem cells into osteoblasts using pulse electromagnetic field.OBJECTIVE: To investigate the differentiation of mouse MSCs into osteoblasts in vitro following stimulation of pulse electromagnetic field.DESIGN, TIME AND SETTING: The cytological in vitro controlled study was conducted at the Laboratory of Department of Orthopaedics, Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology from May 2004 to October 2007.MATEIRALS: Totally 20 BALB/C mice were supplied by the Experimental Animal Center of Tongji Medical College. Pulse electromagnetic field deviser was designed and made by the Department of Electric Machine, Naval University of Engineering.METHODS: Mouse bilateral femur was sterilely isolated. BMSCs were harvested by the Percoll density gradient centrifugation,and purified and proliferated by the adherent method. Cells at the third passage (2×10~7/L) were incubated in a 6-well plate, and then divided into 4 groups. Cells in the blank control group were incubated in the complete medium. Cells in the pulse electromagnetic field underwent pulse electromagnetic field radiation of 50 Hz, sinusoidal wave, and 1 mT, twice a day, once 30 minutes, with an interval of 12 hours, totally 10 days. Cells in the osteogenic induction group were incubated in the complete medium, supplemented with dexamethasone, sodium glycerophosphate and VitC. Cells in the pulse electromagnetic field + osteogenic induction group were subjected to the same pulse electromagnetic field radiation and then incubated in the complete medium.MAIN OUTCOME MEASURES: The differentiation of BMSCs was measured.RESULTS: Results of alkaline phosphatase staining showed that cells were negative in the blank control group, but weakly positive in the pulse electromagnetic field group, positive in the osteogenic induction group, and strongly positive in the pulse electromagnetic field + osteogenic induction group 10 days following intervention. Compared with the blank control group,absorbance value of type I collagen immunohistochemistry was significantly greater in the osteogenic induction group, pulse electromagnetic field + osteogenic induction group (P < 0.05, P < 0.01).CONCLUSION: Pulsed electromagnetism fields of 50 Hz, waves of sine, with the intensity of 1 mT could promote alkaline phosphatase and type I collagen expression and enhance the differentiation of mouse BMSCs into osteoblasts in vitro.

Objective To investigate the therapeutic effect of lengthening and rotational osteotomy of the fibula for lateral malleolar malunion. Methods Twenty-three patients who had suffering from the traumatic arthritis of ankle were due to lateral malleolar malunion treated with lengthening and rotational osteotomy from October 2005 to July 2008. Special radiographs were use to fully detect the extent of shortening and rotation of the fibula. The Lengthening and rotational osteotomy could be conducted with a special compression/distraction device and bone graft. The function of the ankles was evaluated by the American Orthopedic Foot Ankle Society (AOFAS) scoring system. Serial radiographs of the ankle were made to assess the bone healing and changes of posttraumatic osteoarthritis. Results Seventeen of 23 patients were followed up, with a mean 29.1 months (12-45 months). All the fractures were healed. The mean bone healing time was 13.3 weeks (11-16 weeks) and the mean time of total weight-bearing was 12.1 weeks (11-15 weeks). The ankle function score had improved from 29 (21-47) preoperatively to 81 (56-91)12 months after the operation. There was 5 in excellent, 8 in good, 3 in mild, 1 in poor, and the rate of good outcomes was 76.5%. After the operation, 1 patient had a skin necrosis around the wound which healed by conservative treatment. A slightly aggravated degeneration of the ankle joint was seen in 2 patients who responded to conservative managements. No failure of the internal fixation was noted in this group. Conclusion The outcomes demonstrate that reconstructive lengthening osteotomy is well worthwhile when there is absent or minimal osteoarthritic change, regardless the time from the original injury. Lengthening of the fibula is an important step in the treatment of the painful ankle when the fibula become shorter after injury, even when degenerative changes of the joint are already present. The lengthening of the fibula could lead to a good outcome in ankle with lateral malleolar malunion.

Objective To observe enhancing effect of nerve regeneration on peripheral nerve defect models bridged by silicone tube idled with valproic acid (VPA). Methods In present research we demon-strate the effect of VPA on peripheral nerve regeneration and recovery of motor function following sciatic nerve transaction in rats. An 8-mm sciatic nerve deficit was created in a rat mode land bridged by a 1-cm silicone tube.Then, 10 lad of 8% VPA were perfused into the silicone chamber in the VPA group. The same volume of normal saline was delivered in the control group. Results Each animal was observed sciatic nerve function index (SFI) at 2-week intervals and studied electrophysiology at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed at the end of the experiment, 12 weeks after operation. Using the digital image-analysis system, thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. There was a significant difference in SFI, electrophysiological index (motor-nerve conduct velocity, MCV), and morphometrical results (regenerated axon number and thickness of myelin sheath) in nerve regeneration between the VPA group and controls (P ＜ 0.05). Conclusion The results demonstrated that VPA is able to enhance sciatic nerve regeneration in rats, suggesting the potential clinical application of VPA for the treatment of peripheral nerve injury in humans.

We investigated the development of an injectable, biodegradable hydrogel composite of poly(trimethylene carbonate)-F127-poly(trimethylene carbonate)(PTMC11-F127-PTMC11 )loaded with bone morphogenetic protein-2 (BMP-2) derived peptide P24 for ectopic bone formation in vivo and evaluated its release kinetics in vitro. Then we evaluated P24 peptide release kinetics from different concentration of PTMC11-F127-PTMC11 hydrogel in vitro using bicinchoninic acid (BCA)assay. P24/ PTMC11-F127-PTMC11 hydrogel was implanted into each rat's erector muscle of spine and ectopic bone formation of the implanted gel in vivo was detected by hematoxylin and eosin stain (HE). PTMC11-F127-PTMC11 hydrogel with concentration more than 20 percent showed sustained slow release for one month after the initial burst release. Bone trabeculae surround the P24/ PTMC11-F127-PTMC11 hydrogel was shown at the end of six weeks by hematoxylin and eosin stain. These results indicated that encapsulated bone morphogenetic protein (BMP-2) derived peptide P24 remained viable in vivo, thus suggesting the potential of PTMC11-F127-PT- MC11 composite hydrogels as part of a novel strategy for localized delivery of bioactive molecules.
Animals ; Biocompatible Materials ; chemistry ; Bone Morphogenetic Proteins ; pharmacology ; Bone and Bones ; drug effects ; Dioxanes ; chemistry ; Drug Delivery Systems ; Hydrogels ; chemistry ; Osteogenesis ; drug effects ; Peptides ; Prostheses and Implants ; Rats

Objective To evaluate the clinical outcome of lateral malleolar's anatomical hook-plate in treating ankle fracture including distal fibular fracture. Methods Nineteen patients of ankle fracture including distal fibular fracture were treated from January 2006 to January 2009. There were 12 males and 7 females with an average age of 36 years (range, 18-72 years). The fractures were classified by Danis-Weber system. There were A type in 8 cases, B type in 11 cases. The average time of duration between injury and operation was 6 days (ranged from 6 hours to 16 days). The distal fibular fracture were treated with lateral malleolar's anatomical hook-plate. The medial malleolus was fixed with cancellous bone screw. The posterior malleolus was fixed with screw or plate according to the pattern of fracture. Results The mean follow-up period was 18.8 months with a range from 6 to 32 months. No obvious fracture line could be seen on the radiographs 4-6 weeks after operation. Bone healing was achieved in 10 cases 12 weeks after operation and in 9 cases 20 weeks after operation. All surgical incisions healed adequately. There were no instances of infection, instability of ankle and other complications. According to Mazur ankle joint scoring scale system, the fiual result was scored from 67 to 92 (average 86.3). There were excellent in 12 cases, good in 4, fair in 2,and poor in 1 case. The excellent and good rate was 84.2%. Conclusion The lateral malleolar's anatomical hook-plate represents a definite biomechanical superiority in treating fracture of the external malleolus, with advantage of restoring anatomic structure, joint activity effectively and firm fixation.

Objective To investigate the clinical effects of tibiotalocalcaneal arthrodesis (TTCA) using a retrograde intramedullary nail with a valgus curve.Methods At our department,22 patients underwent TTCA using a retrograde intramedullary nail with a valgus curve from June 2009 to January 2014 and were available for complete follow-up.They were 12 men and 10 women,aged from 46 to 79 years (average,62.2 years).There were 3 cases of primary ankle osteoarthritis,9 ones of traumatic arthritis,one of ankle arthritis secondary to severe talar avascular necrosis,3 ones of progressive subtalar arthritis following failed ankle replacement,5 ones of progressive subtalar arthritis following failed ankle arthrodesis,and one of arthritis secondary to equinovarus.The outcome measurements included the American Foot and Ankle Society (AOFAS) ankle-hindfoot scale,EQ-5DTM functional score,radiologic assessment and clinical examination.Results The mean follow-up was 21.3 months (range,from 14 to 38 months).A plantigrade foot and bony union were achieved in all the patients after a mean time of 3.9 months (range,from 2.4 to 6.2 months).Postoperative radiologic results showed a good hindfoot alignment in all the patients.Superficial infection occurred in one patient and loosening of the distal screw in another who asked for removal.The mean postoperative EQ-5DTM functional score and AOFAS ankle-hindfoot score were 69.3 (range,from 20 to 90) and 69.9 (range,from 45 to 85),respectively.Conclusion TTCA using a retrograde curved intramedullary nail may lead to solid fusion and good hindfoot alignment.

Objective To evaluate the clinical effect of absorbable self-enhancing cartilage nails in the treatment of radial head fractures.Methods Data of 22 patients with radial head fractures,who had undergone open reduction and internal fixation with absorbable self-enhancing cartilage nails from January 2008 to December 2011,were retrospectively analyzed.Among them,data of 18 patients were complete,including 10 males and 8 females.According to the Mason classification,there were 14 cases of Mason Ⅱ,3 cases of Mason Ⅲ and 1 case of Mason Ⅳ.Two patients were combined with radial neck fractures,9 with osteochondral fractures of capitellum,and 1 with posterior dislocation of the elbow and olecranon avulsion fracture.The radial head fractures were temporarily fixed with Kirschner wires after open reduction,then absorbable self-enhancing cartilage nails with length from 16 to 24 mm and diameters of 1.5 mm were applied to reach final fixation.The heads of nails were right underneath of cartilages without penetrating bone cortexes on the contralateral side.The radial neck fractures were reduced and fixed with T-plates or anatomical plates after the radial head fractures were fixed with cartilage nails.Four cases of osteochondral fracture of capitellum were fixed with absorbable sutures to external epicondyle of humerus.For other 5 cases of osteochondral fracture of capitellum,the bone fragments were removed due to too small to fix.Results All 18 patients were followed up for 6 to 54 months (average,31.3 months).All fractures achieved bone union,and the healing time ranged from 5 to 12 weeks (average,8.7 weeks).There were no complications,such as internal fixation failure,nonunion,hematoma,sinus formation,osteolytic changes of radial heads and so on.According to the Broberg-Morrey elbow performance score,13 cases were excellent,4 good,and 1 fair,with the total excellent and good rate of 94.44％ (17/18).At final follow-up,the elbow range of motion was 90° to 150° (average,123.8°),and the range of forearm rotation was 130° to 180° (average,152.5°).Conclusion Absorbable self-enhancing cartilage nails can be used to treat various kinds of radial head fractures,and the results are satisfactory.

Objective To investigate the clinical effect of the free fibula composite tissue flap transplantation to repair the first metatarsal bone with soft tissue defect on foot.Methods From August, 2008 to August, 2013, 6 patients with the first metatarsal bone and soft tissue defect on foot were treated with transplantation of free fibula composite tissue flap.The causes: 2 cases in traffic accident injury, 4 cases in machine injury;3 cases with traumatic defect, and septic defect in 3 patients.Of the 6 cases, the fibular length with transplantation was 6 cm to 12 cm, and the flap area was 8 cm × 5 cm-18 cm × 16 cm;All the cases were followed-up in 3, 6, 12 months postoperatively to observe the fracture healing, and to assess injured limb function in 1 year postoperatively.Results All cases were followed up 12-24 months, and average of 14 months;All the flaps survived, and the metatarsal bone and fibula healing was good visibly in half a year, The surgery function were assessed according to Maryland's scale, and the excellent were 2 and the good were 4.Conclusion The transplantation of free fibula composite tissue flap to repair the first metatarsal bone with soft tissue defect on foot is a safe and effective strategy, and it has the advantages such as covering the wound at foot approvingly, one-time rebuild repair foot weight bearing area and the surrounding soft tissue defect, shorten the treatment cycle, for small area damage in donor area, and the function postoperative is good, etc.